Oral Cancer And Oral Habits
January 17, 2025
Cochlear Implant DocCast by Dr Akbar Abbas
January 31, 2025Oral Cancer And Oral Habits
January 17, 2025Cochlear Implant DocCast by Dr Akbar Abbas
January 31, 2025Clinical Examination of Nose And Paranasal for undergraduate and post graduate students.
In this detailed guide, Dr. Akbar Abbas walks you through the essential steps of conducting a thorough nasal examination, including both anterior and posterior rhinoscopy. This procedure is fundamental in diagnosing nasal and paranasal sinus conditions.
Preparing for the Examination
Before starting, ensure you have the necessary tools:
- A functioning headlight for optimal visibility.
- A Thudichum nasal speculum (30-degree nasal speculum) for anterior rhinoscopy.
Always begin by asking the patient if they are experiencing any nasal pain or tenderness.
Step 1: Inspection of the Nose
Begin with a systematic inspection:
- Frontal View:
- Look for nasal asymmetry, scars, discharges, redness, or swelling.
- Base of the Nose:
- Inspect the nostrils and columella for deformities or dislocations.
- Lateral Views:
- Examine both sides of the nose for any deviations, nasal humps, saddling, or signs of inflammation.
- Posterior View:
- Assess the nasal bridge for external deformities or asymmetry.
Step 2: Palpation of the Nose
Gently palpate:
- The nasal bridge, bony prominences, and frontal sinuses to detect tenderness or swelling.
- Lift the nasal tip and inspect the nasal vestibule and septum for polyps, boils, discharges, or septal dislocation.
Step 3: Anterior Rhinoscopy with Speculum
Using the 30-degree nasal speculum:
- Hold the instrument in your left hand using your thumb and index finger.
- Gently insert the speculum into the nasal cavity, opening and closing it smoothly using your middle and ring fingers.
- Always examine both nostrils systematically.
Step 4: Tests for Nasal Patency
- Cottle Test:
- Laterally pull the patient’s cheek to widen the nasal valve area. Improved breathing suggests a deviated nasal septum (DNS).
- Learn more about DNS from Mayo Clinic
- Cotton Wool Test:
- Occlude one nostril and place a piece of cotton wool near the other to assess airflow.
- Mirror or Spatula Test:
- Place a metallic spatula or mirror below the nostrils. Fogging indicates patency on that side.
Step 5: Olfactory Function Test
- Place a pleasant-smelling substance on a cotton swab.
- Ask the patient to close one nostril and detect the smell with the other nostril, then repeat on the opposite side.
- Read about the olfactory nerve and anosmia at Johns Hopkins Medicine
Step 6: Nasal Probe Test
- This test differentiates between a nasal polyp and a turbinate:
- If the probe can move around the entire swelling, it’s likely a polyp.
- If not, it may be an enlarged turbinate.
- Also, palpate the turbinate against the septum for confirmation.
More about nasal polyps from the American Academy of Otolaryngology
Step 7: Trigeminal Nerve Sensory Test
- Test the sensory branches of the trigeminal nerve on both sides of the face.
- Instruct the patient to close their eyes during the test.
Step 8: Posterior Rhinoscopy
For posterior rhinoscopic examination:
- Hold a tongue depressor in your left hand.
- Use a pre-warmed posterior rhinoscopy mirror with your right hand.
- Gently depress the tongue and slide the mirror behind the soft palate to visualize the posterior nasal cavity, choanae, eustachian tube openings, and check for adenoids or neoplastic growths.
Learn more about posterior rhinoscopy from StatPearls
Final Step: Thank Your Patient
Always conclude by thanking your patient for their cooperation.
Why Nasal Examination Matters
A thorough nasal exam is essential for diagnosing conditions like deviated nasal septum, nasal polyps, hypertrophied turbinates, and neoplastic lesions. Early detection can significantly improve treatment outcomes.
